ncontinence is an involuntary leaking of urine. It is a very common and upsetting problem, but many women will not consult their doctors about this problem, as it is quite embarrassing. This burden and embarrassment may however affect self-esteem and place stress on relationships. There are 3 main types of incontinence: stress, urge, and mixed incontinence. More than half of incontinence is due to weakness of the neck of the bladder. This type is called stress incontinence.
Urinary Stress Incontinence is the leaking of small amounts of urine during normal, daily physical activities, such as laughing, coughing or exercise.
It affects women in all age groups, but the most common predisposing factors are childbirth and pregnancy. Other risk factors include obesity, smoking, and hysterectomy.
Urodynamic tests, which look at the function of the bladder, are performed to clarify the diagnosis but these tests are not always necessary as many patients can be treated symptomatically.
It’s now easier to get specialist help and appropriate treatment, than before. Help is available through lifestyle changes, various medications, pelvic floor exercises and surgery. There are available devices (pelvic toners, cones, etc), which help to ensure that pelvic floor exercises are done correctly and effectively, but patients need to be very motivated. It can take up to six months of regular exercises to notice a realistic difference. New medications are available for both types of incontinences, but the treatment of urge incontinence is largely medical. Side effects can limit prolonged use.
Surgery for Stress Incontinence
There are many different operations for stress incontinence. Recent advances have lead to the development of Injectables, which are compounds that can be injected around the urethra to help it to close more effectively. The newest and most hopeful of these is called Bulkimaid. Bulkimaid, is a new minimally invasive treatment for Stress Urinary Incontinence. This involves injection of Hyaluronic acid around the urethra at the bladder neck, which allows it to close more effectively and therefore improve or cure incontinence. (Hyaluronic acid occurs naturally throughout human body). This procedure can be done in the clinic setting, under local anaesthesia. About 30-40% of patients are cured of their incontinence whilst overall 60-70% will see a significant improvement after treatment. This procedure is particularly beneficial to younger women who have worrying stress incontinence, which is not severe enough to justify major surgery. It allows for vaginal birth in future, which is not the case with other surgical treatments. The treatment can last up to 3 years and it can easily be repeated when necessary. Although the cure rates are not as high as the more invasive operation, as a walk-in procedure, that takes only a few minutes, this treatment, is acceptable to many women who leak urine on exertion, who want more than pelvic floor exercises, but who do not wish for more involving surgical procedure.
Sub-urethral Sling; e.g. Tension free Vaginal Tape (TVT): This is now the most widely performed operation for stress incontinence. The idea behind it is that stress incontinence results from weakness of the supporting tissues of the urethra, from the top to the middle portion. The aim of the tape is to reinforce the supports to the mid-urethra and thus restore continence. The procedure can be performed under local, regional or general anaesthesia. The tape or sling is placed at the mid-urethra. Your specialist can discuss more with you about the pros and cons of this procedure. However, the major advantage of the TVT over the long established Colposuspension, is that it has a very quick recovery time. Colposuspension involved an abdominal incision and elevating the neck of the bladder, to avoid loss of urine, during cough. The results are quite similar with both procedures, but complications are different.
Patients for TVT are treated as day cases or have an overnight stay in hospital, and most are fully back to normal within two weeks. After colposuspension, patients stay in hospital for about five days and it is can take up to six weeks before they can resume normal activities. There are different types and modifications of these TVT-type sling procedures.